| |
|
|
A BILL TO BE ENTITLED
|
|
|
AN ACT
|
| |
|
|
relating to electronic health record requirements; authorizing a |
|
|
civil penalty. |
|
|
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
|
|
SECTION 1. Subtitle I, Title 2, Health and Safety Code, is |
|
|
amended by adding Chapter 183 to read as follows: |
|
|
CHAPTER 183. ELECTRONIC HEALTH RECORDS |
|
|
Sec. 183.001. DEFINITIONS. In this chapter: |
|
|
(1) "Biological sex" means the biological trait that |
|
|
determines whether a sexually reproducing organism produces male or |
|
|
female gametes. |
|
|
(2) "Covered entity" has the meaning assigned by |
|
|
Section 181.001. The term includes a health care practitioner. |
|
|
(3) "Female" means an individual whose reproductive |
|
|
system is developed to produce ova. |
|
|
(4) "Health care practitioner" means an individual who |
|
|
is licensed, certified, or otherwise authorized to provide health |
|
|
care services in this state. |
|
|
(5) "Male" means an individual whose reproductive |
|
|
system is developed to produce sperm. |
|
|
(6) "Sexual development disorder" means a congenital |
|
|
condition associated with atypical development of internal or |
|
|
external genital structures. The term includes a chromosomal, |
|
|
gonadal, and anatomic abnormality. |
|
|
Sec. 183.002. REQUIREMENTS FOR ELECTRONIC HEALTH RECORD |
|
|
STORAGE. (a) A covered entity shall ensure that electronic health |
|
|
records under the control of the entity that contain patient |
|
|
information are physically maintained in the United States or a |
|
|
territory of the United States. This subsection applies to: |
|
|
(1) electronic health records that are stored by a |
|
|
third-party or subcontracted computing facility or an entity that |
|
|
provides cloud computing services; and |
|
|
(2) electronic health records that are stored using a |
|
|
technology through which patient information may be electronically |
|
|
retrieved, accessed, or transmitted. |
|
|
(b) A covered entity shall ensure that the electronic health |
|
|
record information of this state's residents, other than open data, |
|
|
is accessible only to individuals who require the information to |
|
|
perform duties within the scope of the individual's employment |
|
|
related to treatment, payment, or health care operations. |
|
|
(c) Each covered entity shall implement reasonable and |
|
|
appropriate administrative, physical, and technical safeguards to |
|
|
protect the confidentiality, integrity, and availability of |
|
|
electronic health record information. |
|
|
Sec. 183.003. REQUIRED MEDICAL HISTORY INFORMATION IN |
|
|
ELECTRONIC HEALTH RECORD. A covered entity shall ensure each |
|
|
electronic health record maintained for an individual includes the |
|
|
option for a health care practitioner to collect and record |
|
|
communications between two or more covered entities related to the |
|
|
individual's metabolic health and diet in the treatment of a |
|
|
chronic disease or illness. |
|
|
Sec. 183.004. INFORMATION RESTRICTIONS IN ELECTRONIC |
|
|
HEALTH RECORD. A covered entity may not collect, store, or share |
|
|
any information regarding an individual's credit score or voter |
|
|
registration status in the individual's electronic health record. |
|
|
Sec. 183.005. ARTIFICIAL INTELLIGENCE IN ELECTRONIC HEALTH |
|
|
RECORD. (a) A health care practitioner who uses artificial |
|
|
intelligence for diagnostic purposes, including the use of |
|
|
artificial intelligence for recommendations on a diagnosis or |
|
|
course of treatment based on a patient's medical record, shall |
|
|
review all records created with artificial intelligence to ensure |
|
|
that the data is accurate and properly managed. |
|
|
(b) A health care practitioner who uses artificial |
|
|
intelligence for diagnostic purposes as described by Subsection (a) |
|
|
must disclose the practitioner's use of that technology to the |
|
|
practitioner's patients. |
|
|
Sec. 183.006. ACCESS TO ELECTRONIC HEALTH RECORD OF MINOR. |
|
|
(a) In this section, "minor" means an individual 17 years of age or |
|
|
younger who has not had the disabilities of minority removed for |
|
|
general purposes. |
|
|
(b) A covered entity shall ensure each electronic health |
|
|
record system the entity uses to store electronic health records of |
|
|
minors allows a minor's parent or, if applicable, the minor's |
|
|
managing conservator or guardian to obtain complete and |
|
|
unrestricted access to the minor's electronic health record |
|
|
immediately upon request, unless access to all or part of the record |
|
|
is restricted under state or federal law or by a court order. |
|
|
Sec. 183.007. ELECTRONIC HEALTH RECORD REQUIREMENTS |
|
|
REGARDING BIOLOGICAL SEX. (a) Notwithstanding any other law, the |
|
|
commission, the Texas Medical Board, and the Texas Department of |
|
|
Insurance shall jointly ensure that: |
|
|
(1) each electronic health record prepared or |
|
|
maintained by a covered entity in this state includes a separate |
|
|
space for the entity to document: |
|
|
(A) an individual's biological sex as either male |
|
|
or female based on the individual's observed biological sex |
|
|
recorded by a health care practitioner at birth; and |
|
|
(B) information on any sexual development |
|
|
disorder of the individual, whether identified at birth or later in |
|
|
the individual's life; and |
|
|
(2) any algorithm or decision assistance tool included |
|
|
in an electronic health record to assist a health care practitioner |
|
|
in making medical treatment decisions includes an individual's |
|
|
biological sex as recorded in the space described by Subdivision |
|
|
(1)(A). |
|
|
(b) This section does not prohibit an electronic health |
|
|
record from including spaces for recording other information |
|
|
related to an individual's biological sex or gender identity. |
|
|
Sec. 183.008. AMENDING CERTAIN BIOLOGICAL SEX INFORMATION |
|
|
IN ELECTRONIC HEALTH RECORDS. (a) A covered entity may amend on an |
|
|
electronic health record an individual's biological sex as recorded |
|
|
in the space described by Section 183.007(a)(1)(A) only if: |
|
|
(1) the amendment is to correct a clerical error; or |
|
|
(2) the individual is diagnosed with a sexual |
|
|
development disorder and the amendment changes the individual's |
|
|
listed biological sex to the opposite biological sex. |
|
|
(b) If an individual's biological sex is amended under |
|
|
Subsection (a)(2), the covered entity shall include in the |
|
|
individual's electronic health record information on the |
|
|
individual's sexual development disorder in the space described by |
|
|
Section 183.007(a)(1)(B). |
|
|
Sec. 183.009. PROHIBITION ON COVERED ENTITY PARTICIPATION |
|
|
UNDER MEDICAID AND CHILD HEALTH PLAN PROGRAM. (a) In this section, |
|
|
"child health plan program" and "Medicaid" have the meanings |
|
|
assigned by Section 521.0001, Government Code. |
|
|
(b) The executive commissioner by rule shall prohibit a |
|
|
covered entity that violates this chapter from participating as a |
|
|
health care provider under Medicaid or the child health plan |
|
|
program for a period that is reasonably proportionate to the |
|
|
seriousness and frequency of the violation, as the executive |
|
|
commissioner determines. In adopting rules under this section, the |
|
|
executive commissioner shall ensure that the period during which a |
|
|
covered entity is prohibited from participating as a provider under |
|
|
Medicaid or the child health plan program runs concurrently with |
|
|
the period during which the covered entity's license, registration, |
|
|
certification, or other regulatory authorization is suspended or |
|
|
revoked by a regulatory agency under Section 183.011, as |
|
|
applicable. |
|
|
Sec. 183.010. INVESTIGATION BY COMMISSION OR REGULATORY |
|
|
AGENCY. The commission or the appropriate regulatory agency shall |
|
|
conduct an investigation of any credible allegation of a violation |
|
|
of this chapter by a covered entity. The commission or agency shall |
|
|
ensure the investigation is conducted in compliance with all |
|
|
applicable state and federal laws, including the Health Insurance |
|
|
Portability and Accountability Act of 1996 (Pub. L. No. 104-191). |
|
|
Sec. 183.011. DISCIPLINARY ACTION BY REGULATORY AGENCY. |
|
|
The appropriate regulatory agency may take disciplinary action |
|
|
against a covered entity that violates this chapter three or more |
|
|
times in the same manner as if the covered entity violated an |
|
|
applicable licensing or regulatory law. The disciplinary action |
|
|
may include license, registration, or certification suspension or |
|
|
revocation for a period the agency determines appropriate. |
|
|
Sec. 183.012. INJUNCTIVE RELIEF; CIVIL PENALTY. (a) The |
|
|
attorney general may institute an action for injunctive relief to |
|
|
restrain a violation of this chapter. |
|
|
(b) In addition to the injunctive relief provided by |
|
|
Subsection (a), the attorney general may institute an action for |
|
|
civil penalties against a covered entity for a violation of this |
|
|
chapter. A civil penalty assessed under this section may not |
|
|
exceed: |
|
|
(1) $5,000 for each violation that is committed |
|
|
negligently and that occurs in a single year, regardless of how long |
|
|
the violation continues during that year; |
|
|
(2) $25,000 for each violation that is committed |
|
|
knowingly or intentionally and that occurs in a single year, |
|
|
regardless of how long the violation continues during that year; or |
|
|
(3) $250,000 for each violation in which the covered |
|
|
entity knowingly or intentionally used protected health |
|
|
information for financial gain. |
|
|
Sec. 183.013. MEMORANDUM OF UNDERSTANDING; RULES. The |
|
|
executive commissioner, the Texas Medical Board, the Texas |
|
|
Department of Licensing and Regulation, the Texas Department of |
|
|
Insurance, and each regulatory agency subject to this chapter shall |
|
|
enter into a memorandum of understanding and, as necessary, adopt |
|
|
rules to implement this chapter. |
|
|
SECTION 2. (a) Except as provided by Subsection (b) of this |
|
|
section, Chapter 183, Health and Safety Code, as added by this Act, |
|
|
applies only to an electronic health record prepared on or after the |
|
|
effective date of this Act. |
|
|
(b) Section 183.002, Health and Safety Code, as added by |
|
|
this Act, applies to the storage of an electronic health record on |
|
|
or after January 1, 2026, regardless of the date on which the |
|
|
electronic health record was prepared. |
|
|
SECTION 3. If before implementing any provision of this Act |
|
|
a state agency determines that a waiver or authorization from a |
|
|
federal agency is necessary for implementation of that provision, |
|
|
the agency affected by the provision shall request the waiver or |
|
|
authorization and may delay implementing that provision until the |
|
|
waiver or authorization is granted. |
|
|
SECTION 4. This Act takes effect September 1, 2025. |
|
|
|
|
|
* * * * * |